Reimbursement methodology changes revised to begin with dates of service on or after Dec. 1, 2024.
Topics Related to Medicaid Managed Care
Standard Plans will reimburse the APM rate for claims with a date of service on or after Aug. 1, 2024.
The strategy outlines visions and goals for NC Medicaid Managed Care for the next three years.
NC Medicaid has released a new online tool for beneficiaries to compare the five available Standard Plans. The 2025 NC Medicaid Standard Plan Performance Comparison Tool is now available online.
Providers can continue billing Diagnosis Related Group claims using revenue code 0161 for room and board and occurrence span code 82.
Temporary flexibilities to the Innovations Waiver after Hurricane Helene are ending July 1, 2025.
The Centers for Medicare & Medicaid Services (CMS) requires individuals in the NC Medicaid Innovations waiver program to have a valid and comprehensive assessment.
NC Medicaid’s Electronic Visit Verification (EVV) system for Home Health ensures compliance with federal requirements.
Care Management rate considerations effective July 1, 2025.
Reminder: NC Medicaid does not require Carolina Access/Advanced Medical Home referrals for specialty care.